Medicare insurance coverage is available to qualifying applicants who are 65 years of age and older, have a disability or meet other eligibility requirements. Medicare coverage may also be purchased under certain circumstances. Part A Medicare premiums are sometimes covered, depending on the situation. However, Medicare premiums must be paid by each applicant for Medicare Part B. Medicare costs are usually deducted from Social Security, Railroad Retirement or Civil Service Retirement checks. Below, Medicare applicants can find information on Medicare insurance coverage and premiums:

  • What does Medicare cover in Texas?
  • Medicare A and B coverage in Texas
  • Texas Medicare premiums explained
  • Medicare savings programs in Texas
  • PACE services in Texas
  • Paying for Medicare in Texas

What Medicare Covers in Texas

Medicare insurance coverage is a health insurance program available to qualifying U.S. citizens. However, Medicare covered services vary depending on the Medicare plan. Medicare Part A coverage includes hospital insurance and may be used at any hospital that accepts Medicare insurance. Medicare Part B coverage pays for medical coverage. Other Medicare covered services include Medicare Part C and Medicare Part D, which include the Medicare Advantage Plan and the prescription drug plan.

Qualifying individuals who wish to receive Medicare covered services may enroll in Medicare Part B without buying Part A. However, all applicants who enroll in Part A must also enroll in Part B. Applicants applying for Medicare Part A coverage or Part B coverage can also apply for Part D, prescription drug coverage. However, individuals who wish to receive Part C Medicare coverage must be enrolled in both Medicare Part A and Part B.

Medicare A and B Coverage in Texas

Medicare A and B coverage includes hospital insurance or medical insurance. Medicare Part A coverage includes in-patient hospital services, nursing care after a hospital stay, home health care, hospice care and several blood draws each year. Medicare Part B coverage includes medical expenses, home health care, laboratory services, outpatient hospital treatment, medical equipment and supplies, shots, health screenings and preventative health services.

Medicare A and B coverage covers many medical and hospital services, but several services are not covered under these plans. Medicare coverage does not include long-term care, custodial care, more than 100 days of nursing home care following a hospital stay, private-duty nursing care, homemaker services, dentures or dental care, routine foot care, cosmetic surgery, eyeglasses, routine eye care, hearing aids and health care while traveling outside of the U.S.

Texas Medicare Premiums Explained

Most petitioners are required to pay monthly Medicare premiums for Medicare A and B plans. Additionally, Medicare co-pays, deductibles and coinsurance costs are required by the applicant. Additional fees also apply for non-Medicare covered services. While a candidate may not be required to pay Medicare premiums for Part A plans, each applicant must pay premiums for Part B plans. Medicare premiums change at the beginning of each year.

Medicare Savings Programs in Texas

For a low-income applicant who cannot afford to pay Medicare costs and premiums, state programs are available to assist the petitioner with Medicare expenses. TX Medicare savings programs are available to assist an applicant with paying for monthly Medicare premiums, deductibles, co-pays and coinsurance costs.

Medicare savings programs are available to candidates who meet the following qualifications

  • Medicare eligibility
  • Does not own or pay for items over a certain amount (excluding vehicles, homes, certain burial funds and other personal belongings)
  • Single candidates paying for Medicare who earn between $733 and $1,962 per month
  • Married candidates paying for Medicare who earn between $1,001 and $2,655 per month

Available Medicare savings programs include the Qualified Medicare Beneficiary Program (QMB), Specialized Low-Income Medicare Beneficiary Program (SLMB), the Qualified Individuals Program (QI) and the Qualified Disabled Working Individuals Program (QDWI). The QMB Medicare savings program covers Part B premiums and all deductibles and copayments. The other listed savings programs help with paying for Medicare Part A or Part B premiums.

PACE Services in Texas

Additionally, PACE is also available to eligible candidates. TX PACE services are available to Medicare recipients who are 55 or older, live near a local service area and need nursing home-level care but can live safely in the community with assistance from Texas PACE organizations. PACE programs include Medicare Part D prescription drug coverage as well as home care, primary day care, dentistry, emergency services, hospital care, laboratory services, nursing home care, nutritional counseling, physical and occupational therapy, preventative care, social services, transportation to Texas PACE locations and more.

Paying for Medicare in Texas

For an applicant receiving Medicare insurance coverage, several payment options are available. An applicant who signs up to receive Medicare Part B coverage but does not get Social Security, Railroad Retirement or Civil Service benefits will receive a bill titled Notice of Medicare Premium Payment Due. An applicant who signs up for Medicare Part A coverage will always receive a Notice of Medicare Premium Payment Due.

When paying for Medicare, an applicant may pay directly through his or her bank account or through Medicare Easy Pay, a free service that automatically deducts payments from a savings or checking account. An applicant may also pay Medicare costs and premiums by check, money order or by credit or debit card.